Dangerous Delivery Shows Peril of Multiple C-sections

The worst surgical case of my residency came when we delivered my patient's baby by cesarean - her ninth cesarean birth.

The baby came out fine, but for the mother we suspected one of most feared complications in obstetrics - that her placenta had burrowed deep into the muscle of the uterus.

To get oxygen and nutrients to the fetus, the placenta needs to attach just a few millimeters deep into the uterus. We worried that hers had gone much farther and might eat through the entire thickness of the uterus, keeping it from shrinking back to its normal size after delivery and causing a massive hemorrhage.

We gave a gentle tug on the umbilical cord. Usually the placenta peels off with such gentle pulling, but hers remained stuck - an ominous sign.

The case points out a fundamental truth about surgical delivery: a first cesarean for most women leads to a cesarean with every pregnancy. And while a first section is quick, easy to perform, and rarely complicated, each repeat surgery carries greater risk.

More and more women are finding themselves on the C-section path. Almost one in three babies was delivered by cesarean in 2007, the most recent year for which data are available, an increase of more than 50 percent from a decade earlier.

At the same time, it's becoming harder for mothers to avoid repeat surgery. The number of vaginal births after a C-section fell by two-thirds, to fewer than 10 percent, over the same time period. This year, the National Institutes of Health estimated that since 1996, one-third of hospitals and one-half of doctors who offered vaginal births after a C-section no longer do so.

"There can be tremendous morbidity after three or four or five prior cesarean deliveries," said Gary Cunningham, an OB-GYN professor and former department chair at Southwestern Medical School in Dallas, who chaired the NIH panel.

"Women need to be counseled appropriately and accurately so that they can make an informed decision," Cunningham said. "But this doesn't do much good if she cannot find an obstetrician or hospital that will allow a trial of labor."

Repeat C-sections pose more risk than a first section for many reasons. One factor concerns anatomy. When a doctor performs a first cesarean, the layers of tissue look and feel very different from each other. These visual cues and textures guide the surgeon, indicating exactly where to cut.

The surgery is simple: the surgeon cuts, spreads, and pokes, layer by layer, until reaching the baby. The surgeon first opens the skin a few centimeters above the pubic bone. The fat underneath easily gives way until the connecting fascia is reached. The tough, fibrous fascia, which holds the intestines in the abdomen, is cut at the midline and opened in either direction. The beefy abdominal muscles beneath are spread.

Finally, the glossy peritoneum, the last layer of the abdomen, is entered, and only the uterus lies between the doctor and the baby. In a term patient, the maroon, swollen uterus, flanked by finger-size veins, fills almost the whole abdomen, pushing the intestines up. The surgeon moves the bladder out of the way, cuts the lower uterus open, and is met by a baby's foot, face, elbow, or behind, depending on how the baby is positioned.

The surgeon loses the advantage of good anatomy after the first section. The tissue undergoes scarring, toughens, and blends together as it heals. The variations in color and texture disappear. The intestines and bowel sometimes stick to the healing wound, putting them in harm's way the next time surgery is performed.

These changes increase the chances of an unexpected injury. "Her belly was cement," we'd say to one another during residency after a tough section.

A study from 2006 published in the journal Obstetrics and Gynecology compared C-section complications in more than 30,000 patients. Risks of requiring a large blood transfusion, incurring a bladder injury, needing to be on a ventilator, and ending up in intensive care all increased significantly with the number of sections after the first.

The study also showed greater risk for my patient's complication. Scarring on the inside of the uterus after a cesarean causes the placenta to attach abnormally in future pregnancies. During a first section, the risk of this complication was less than 1 in 400. After a sixth section, the risk ballooned to more than 1 in 15.

So we knew the risks my patient faced from her ninth cesarean and prepared the best we could. We matched extra blood, placed additional IV lines, and arranged for expert surgeons to back us up.

But with my patient's placenta stuck and bleeding, only one option remained: removing the entire uterus with the placenta still attached. Because the pregnant uterus is large, swollen, and filled with blood, a hysterectomy after a delivery is very dangerous and performed only as a last resort.

By the time we finished the surgery, blood covered the floor. Blood filled suction buckets, and saturated our sterile gowns and drapes. Blood-soaked sponges piled up in the corner.

My patient lost three times the entire blood volume of a normal person, sixteen liters in all. Only a massive transfusion kept her alive. Anesthesiologists pumped in 51 units of red blood cells and seven six-packs of platelets.

Vessels deep in her pelvis refused to stop bleeding, and instead of closing her, we packed her abdomen with surgical towels, hoping the pressure would stanch the slow, steady flow. She left the operating room and headed to the intensive-care unit with her abdomen still open.

After a reoperation the following morning and days in the ICU, she stabilized and slowly recovered.

With a first cesarean, the up-front costs - a few more days in the hospital, a longer recovery - may seem reasonable. Only in retrospect can the true costs become apparent.

47 comments:

Even since before I knew anything about anything, I have always been, at the very least, profoundly uncomfortable with the whole idea of c-sections--but this is beyond anything I have ever seen or read. I am horrified and nauseated. Thank you for this knowledge to keep and share.

The risks of what that first cut can do are rarely explained to mothers when giving "consent". And it doesn't always take 9 c/s to see the effect, I had a serious complication with my second. (my second birth story is on my blog).Keep up the good information!

Wow. I've never heard a cesarean described in such detail before. Amazing from a medical point of view, but very scary as to what it is and the complications that can and do arise from even that first section. I feel for this woman that she had to loose her uterus and the option to have biological children, she obviously loves them and likely would have continued.

I ABSOLUTELY did NOT want a c-section. Emri was born 27 hours after my water broke with TONS and TONS of determination from her momma!!! I pushed for five straight hours with a 20 minute break and then three more before she was born. :)

I believe C sections are not good for the healthy delivery of children as the chemicals that create a high are not released and can lead to the mother feeling depressed, not to mention the long time it can take to heal the scar.

Jeremy - this is true (natural birth hormones are not present when c/s is performed as an elective surgery or when mother/baby have been drugged). One way to reduce this (if a c-section is actually NEEDED) is to allow baby to trigger labor in his/her own time so that s/he gets the natural hormones of labor (even if s/he does not get them during the actual birth/stage 2 phase). Even if a mother KNOWS she is going to have a repeat c/s, she can elect to go into natural labor FIRST and then go in for surgery. We do NOT need to schedule c/s except in very rare cases where risk of hemorrhage/placental problems are certain.

Oh wow. To have that many c-sections...I wonder if she knew the risks and decided to get pregnant anyway....I wonder I'd her dr was concerned. Holy cow. This is why I think c-sections should be a last resort thing.

Closing your eyes and hiding under the covers doesn't really change the facts. I had a VBA2C and only because someone woke me up to the dangers of having a 3rd section... hopefully, it was able to help someone else out as well.

Even if it is their only option the OB needs to inform the mother of the risks of multiple c/s.

I had a VBAC in February and every health practitioner I saw informed me about how dangerous a VBAC is and I had to sign numerous consent forms. When I had a c/s for my twins not one person in the office ever mentioned any risks.

When I was speaking to my provider VBAC he never went over the c/s risk, just the VBAC risks.

wow, i am with all of you, especially dealing with the emotional and physical scars of an emergency c after 4 days in labor...i wanted a homebirth, and instead i got what i feared most. two years later i try to look upon it with gratitude for a healthy baby, and amazement my baby was helping me face my fears before she was even born. now i hope my dream of a homebirth will come true with the next, no one really tells you how traumatizing a C -sec is, and i wish it on no one. as ina may says:

"your body is not a lemon, you are not a machine, The Creator is not a careless mechanic. Human female bodies have the same potential to give birth well as aardvarks, lions, rhinoceri, elephants, moose, and water buffalo. Even if it has not been your habit throughout your life so far, I recommend that you learn to think positively about your body."

This freaked me out although it is wonderful to be informed facing the possibility of my second section I am afraid with or without this article. What I really would like to know is if a c/s is "unavoidable" is there anything a woman can do to make it easier for herself as well as the operating physician?

I have 7 children and #4 was an emergency c-section. I have had successful VBACs (one was natural). My own personal rule is if I have to have another section I will get my tubes tied at the same time. I wouldn't want to risk any more pregnancies after that.

I had to have a c-section with my twins because I had a previa and they were very premature. When I became pregnant again, my doctor spelled it all out for us and encouraged a VBAC. He said that if I opted for a c-section then there was a limit on how many they could do- usually 3-5 was what they felt were withing the safe zone- so I really had to think about how many kids I was going to have and if I wanted a c-section I was limited. I felt I was fortunate to have very honest doctors who really wanted me to make an informed decision.

My first was a CS, and with my second I absolutely refused to set foot in the hospital.

For those who say their insurance won't pay for a VBAC - I'd look further into your insurance situation. Doesn't seem legal that a private insurance company can dictate the method of your delivery. If the doctor is a provider for your company, and that doctor performs VBACs, then you should be eligible. DON'T SETTLE!!!

C-sections are a very real threat to the health of every child bearing woman, and by choosing to ignore it because it's "too scary" or "too raw" or "too close to your own experience" is ridiculous. You're perpetuating the cycle.

Educate yourselves and take back your birth and your bodies!!!

I'm very aware that there are several clear medical indications for a c-section, and "my baby didn't fit" is not one of them.

The occurrence of a baby that's truly too big to be birthed is minuscule. If you're laying on your back the whole labor strapped to beeping machines and dripping IV's, then yeah, your baby might not descend properly.

Yes, this is a peaceful parenting site. But part of being a peaceful parent is ensuring that your BABY has the most gentle start to life possible. C-sections are the most VIOLENT welcome to this world a baby could receive.

After reading the article, I have to say the mother has to bear some responsibility. The doctors can't force her to stop having children and we don't know whether or not she was informed of the risks. I find it hard to believe that after that many pregnancies the doctors didn't say anything to her.

Having had a very traumatic csection, I can relate to the mamas here who are upset by this. BUT, as someone who has also had placenta accreta, which is what this article is about, the placenta attaching too deeply in the uterus, IT IS IMPORTANT TO KNOW, to read, to see, to understand that this is a real possibility after a csection, and it can happen and is scary.

I had a VBAC with my second child. And it was not a gentle or peaceful VBAC,in fact it was very traumatic too, but I'll still take it over c/s.

After my son was born, the doctor tried to help deliver the placenta, and like the woman in this story it was found to be attached too deeply. My placenta ripped into pieces and I was hemorrhaging. My midwife tried to get my baby to latch to help stop the bleeding, and it didn't help. They brought in an ultrasound machine and saw there was a lot of placenta in me still, so they had to do a D&C right there right then. And I felt it and had to just squeeze the hands of my doula and deal with it. And pray that I wouldn't need a hysterectomy and they could get it all out and stop the bleeding. They got most of it. I had a long recovery. Bled for over 10 weeks, passed more pieces of placenta at 4 days PP and 2 weeks PP and believe me, THAT is not what you want, it was terrifying and very upsetting and traumatic and scary.

So yes, all women need to know that this is a real risk and even after just one csection it can happen. It happened to me.

I want more kids too, and I'd love to have a homebirth next time after two bad hospital births, but the thought of this happening at home is really scary and I'm still up in the air and not trying to get pregnant until I can feel less afraid.

I think this picture (that a few people on Facebook are complaining about) is very important. Too many issues are made to look pretty preventing us from properly grieving and healing with in that reality. Prayers of healing and support to all the mamas and babies out there.

Every time I read something like this, even if it is just an intro, I cry (as I am now).

I did not know that a second c-section (9 months ago) would scar me this bad mentally and emotionally.

I had an emergency c-section with my first and was forced to have a second one because not a dr in my state would do a VBAC (on ANYONE who'd had a previous c-section), even though I did not pose a risk.

My OB (26 years of experience) exclaimed he had never seen so much scar tissue. I finally stopped bleeding (lightly) a month ago.

We're done.

I love kids, love being a mom, but I cannot go through this again. One or more of the orphans in the world will find our family to be theirs.

There is a lot to take in here! Thank you all for your stories and information. I have only one birth son whom I gave birth to naturally. If it wasn't for my amazingly talented midwife I could have been like many of the women here who had an emergency c-section and may have lost my son.

wow I am so glad I said no to a cs with my first baby! The doctors tried to get me to have one because they were worried my daughter would be too big but I delivered naturally with no problems! it would have been a completely unnecessary cs.

Oh my god,that gave me chills.I have learnt so much in the last year,partly thanks to sites like this and I am so pleased that this information is out there.

I was induced with my 2nd baby 12 months ago,because my first was very big and there were concerns.I knew myself he wasnt but I was ignorant and uninformed and was pleased to be induced at my due date.I almost ended up with a c section as he flipped around and was transverse as the dr was breaking my waters.Thankfully they realized in time and didn't succeed in breaking them.

I spent the next 24 hours praying and keeping myself in what ever position I'd read would help encourage the head down position.It worked and the next day my bubba was born vaginally.I was lucky.

Once the intervention starts,more often follows.

I will never agree to induction of labour ever again.

Armed with the information I have now and the knowledge that my body is built to do this,I am really excited to have a 3rd child.

I feel for all the women who can not have a natural birth,the trauma of a c-section must be horrendous.

If this article helps even 1 woman to make the choice to have a natural birth over an elective c section though, it is a great thing.

For the women who are traumatized by this article,I am truly sorry for your suffering.It makes me very sad to think that the mode of delivery has affected you all so badly.I think I would feel the same way if it happened to me.

Reading this article, my first thought was "do a hysterectomy with the placenta attached", 9 c-sections is a bit ridiculous, everyone I know who got a c-sections says their OBGYNs won't do more than 3 on one woman, how did this woman FIND a MD to take her pregnancy case in the first place?

Everyone says how their MD asked them how they felt about a cs, whereas my first delivery, 27 hrs, 4 hrs pushing, the MD would NOT do a cs, even though I asked her, "what is the cut off point here doc?"

The baby came out, hands up, delivered with the head, sunny side up, totally wrong position but vaginal.

with my 3 other births, all vag, I paid MUCH attention to the baby's position in those final weeks, lots of hands and knees and NO COUCHES!

I delivered a 12 lb (at 38 weeks!) and three 10 lb babies, all vaginal, and I am 5'0" and 110 lbs, 3 of the 4 induced due to size at 39 weeks.

I find it AMAZING I did not need a cs, all the other women in my family have had at least one.

The hysterectomy was a an obvious choice here, but really, the mom should have thought about her birthing history prior to the NINTH child.

I don't think cs are good for anyone, really and this is a great example of why it should not be elective and should be reserved for emergencies.

MDs are worried about malpractice, I understand that. Interesting article!

Don't take this post down from Facebook, women need to know the risks.

My mother almost died in her second c section. Had she been left alone and not forced into an induction, she would have been fine.

Women need to know the risks, this isn't a scare tactic or fear-mongering, it is the truth.

And hopefully for those in the US, your gov't can change your health care.

Doctors can refuse you here, but no hospital can. Most doctors won't refuse you though, The Society of Obstetricians and Gyneacologists of Canada says they doctors are supposed to give a trial of labour unless deemed medically unsafe and a reason needs to be given.

Having had one csection should never be the reason for having a second or third.

I was not scared at all to give birth to my daughter in the comfort of my own home. I was not one bit concerned, worried or frightened. I was thankful that God made my body to give birth to a baby and He gave me the strength to endure the process.

What scared me to death before going into labor was the prospect of needing medical assistance if an emergency arose. But once my water broke and labor started, I knew that my body was doing what it was supposed to do and I didn't have anyone there who put a doubt in my mind.

Our society and the medical model has made birth scary, but it shouldn't be that way.

Thank God for technology for emergencies, but thank him also for creating us with the ability to give birth without fear when there is no interference!

I only hope that the well publicized NIH VBAC policy statement and supporting data from March will help chip away at the incredible C-section rate.

This article reminds me of a discussion I saw on a Cesarean Support Board between a woman with placenta percreta after 4 C-sections who wishes she had gone for VBACs and a woman who had 9 C-sections (and counting) and claimed that complications never arise unless the doctor doing the surgery uses sloppy technique. Um, no, this is the way that many human bodies respond to surgical incisions.

Thank you for sharing this! 4 months ago I had my second baby, first c-section. I had a complication with my uterus contracting around baby's body after the head was delivered and they had to cut it vertically to deliver the body. So i've been told I will have to have c-sections in the future. Fortunately I had already decided I would not be having anymore babies, so this news only strengthened my resolve. With two children I feel they are my priority and to have more would be too much of a risk. If I was this woman I would have died as I object to blood transfusions. So because of this I couldn't consciencely put myself in a situation where the need for one would be higher. I really appreciate having a clearer picture of what went on when I was cut, and a better understanding of why my babie's cheek was cut in the process. I've always had a great fear of being cut open, now I know why! Very happy that when 4wks after and I needed an appendectomy they were able to do it with laproscopy.

Thank you so much for this article. My first son was born c-section due to labor stalling at 8 cen. I didn't want to have a c-section but the dr said it was the only option. As a brand new mom recovering from a c-section was very difficult. It took me months to feel "normal". I still have pain from time to time, due to the scar tissue. I am grateful for a midwife who has helped me VBAC with my last 2 babies. The experience of natural birth is amazing. With in about 3 hours of giving birth I am up and around and feel GREAT!!!! My uterus has held up just fine! My heart aches for women who are not given the option of a natural birth. It is possible to VBAC, one just needs to be careful. Thank you again for writing this!

I've had two C-sections, neither an "unnecessarean", yet neither was planned.

After our second child was born, we made the difficult decision not to get pregnant again, partially due to the risks involved with potentially facing a third c-section (though, I'd try for a VBAC again if it did come down to it).

The realities of c-sections, ANY section - your first or your ninth - need to be understood by women and their partners.

It's so important that women be given the tools, and support, to be able to birth as normally as possible. C-sections are necessary in many cases. But unncessary in FAR more.

What a wonderful, necessarily graphic description of what truly happens in this surgical procedure. It's so disheartening to consistently read the research that a 5-10% cesarean rate is probably the truly "necessary" level, then compare that to the 1/3 of women currently having a surgical birth. Ditto the research showing that for the vast majority of women, VBAC is far safer than a repeat cesarean surgery - and yet the # of hospitals that "allow" VBAC continues to shrink.

My first children (twins) were born at term via a "medically necessary" cesarean after SROM, but before labor had begun because the lower baby was incomplete breech. I was told that it would be impossible to deliver her vaginally, and the risk of a cord prolapse made a trial of labor too risky. Since I had no other options and no way to know if the information I was give was accurate, I consented. No discussion of risks to me, my babies, any future babies besides a consent form stuck under my nose while I was being prepped for surgery.

18 months ago, I gave birth at home to a beautiful 9# daughter. Today, most of the babies delivered by my midwife team are HBACs. In our county, there is no other option for a VBAC than home birth or driving 1-2 hours for a hospital birth, as none of the local hospitals "allow" VBAC. I am lucky to be able to afford to pay out of pocket for the birth expenses. It is outrageous that my health insurance would have paid $30,000-$40,000 for a repeat cesarean in the local hospital, but would not pay 1/10 of that for my baby's home birth.

I did start to bleed significantly during labor, which is one of the possible signs of placenta accretia. However, my midwives calmly and appropriately handled the situation, carefully monitoring both my blood pressure and the baby's heart rate until she was delivered (both remained normal). I wasn't even aware of their worry until after she arrived. There's no question in my mind that had I been in a hospital, I'd have received another cesarean.

I had two highly coerced vivisections for my first two children. My first was premature to the degree that his skull had not yet claified and I had to massege his head back into a round form every time I nursed him, after every nap and his kin was so soft that I couldn't even feel it with my hands.

The OB and other hospital staff, one of whom advised me to 'never take my eyes off of him, even for a minute. When I go pee, take him with me, when I shower, take him in, but never look away from him," would not admit the horrid mistake they had made and the lies that they had told me to coerce me into agreeing to the c/s.

My second was born the same way because nobody would even look at me for a vbac in my region, and this was in Canada, neary six years ago. This time the baby needed lots of help to start breathing and I ended up in ICU, paralysed for three hours and not knowing if I was going to live while my partner held our little rooting newborn and protected him from the vultures in the maternity ward.

I was then refused pain relief when I was finally brought to maternity and later had to give in to taking naarcotics when a new nurse came in and saw that I was going into shock and needed something so that I wouldn't stop reathing from the shock and pain I was in having my abdomen so deeply injured and no pain relief at all.

When i became pregnant with our third child, I knew that the drs would end up killing me or the baby or both of us. Our midwife ordered the surgical records after c/s #2 and they were blank. She had witnessed a lot of non-protocol activities in the surgery and not one thing was documented!!! The form stated my name and the phrase "routine casaian section" and the date. That's it. Nothing about the condition of the baby or my time in ICU or anything. These drs had their butts covered from the very first to the last time I let them touch me.

So, I looked after myself for my thrid, fourth and fifth pregnancies and freebirthed two and am awaiting my fifth child any day now, also a freebirthing intention.

Having a freebirth with my artner in my home with nobody coercing me, experiencing labour for the first time and having a painless childbirth, was the most profoud experience of my life.

My second freebirth was three minutes long and because we lived in a homebirth-hostile town, I knew that I wouldn't be able to let on when I was in labour, so I didn't and couldn't anyway since it was so quick. But I know that my body allowed for such a quick passage because it may otherwise have been stressful for me and the baby to endure whatever other people may have done to us (threats of rocks through our windows and F&CS involvement came after the baby was born and the rumours hadn't yet included that my labour was 3 minutes).

Now I await my third freebirth any day. My two other freebirthed children were 10lbs3oz and 10lbs8oz respectively and born at 46 and 44 weeks respectively. This baby is now at 44+2 and very active, alert and no doubt also big.

Taking charge of my body, my birth and my babies has been a hugely empowering experience for my whole family. I wish anyone, even just one person had said something to me other than, 'it's your choice' in order to not offend me when I 'consented to the first two c/s, but how much of a choice is when an OB bold-facedly lies and tells me that if I don't do the c/s, my babies will die?

My c/s were for frank breech. My babies had no genetic anomolies or health problems except directly resultant from the surgeries. If we lived in England, they would have been born at home in water without interference, and likely not breech since they would have been full term rather than inaccurately ultrasound dated in the second trimester...

Even if it is their only option the OB needs to inform the mother of the risks of multiple c/s.

I had a VBAC in February and every health practitioner I saw informed me about how dangerous a VBAC is and I had to sign numerous consent forms. When I had a c/s for my twins not one person in the office ever mentioned any risks.

When I was speaking to my provider VBAC he never went over the c/s risk, just the VBAC risks.

Amy, that is precisely the problem with the system...they aren't looking at what's BEST for mom, but what's best for THEM. They know that the risks for MOM for a C/S are worse than a VBAC, but the risk for a DOCTOR are more with a VBAC than a C/S. They know if the baby died in surgery they can get away with it because it's considered a life saving operation, but VBAC is considered a high risk delivery. It's sad this is what has become of our medical system.

A retained placenta is a complication that can occur in any pregnancy at any time. My first vaginal birth ended with a retained placenta, and required me to have an operation to have it removed to prevent hemorrhage. It's just a more common complication in csections.

wow. i knew that csections posed the risk that any other surgery does to the mother and baby, but i never realized repeat sections are even more dangerous! i can't wait to have my baby the ol fashion way lol

My first section was an emergency. The cord became wrapped around my sons neck three times and caused him to go into distress as well as myself. I waited 6 yrs to have my second child thinking I would be able to have a VBAC and I was denied. The Dr told me that the hospital and himself did not do vbacs and would not allow them. I was give all of these terrible scanarios that would happen if I had a vbac and was literally scared into having another c-sec. It was horrible. I felt like I had been hit by a truck. I just found out I am pregnant with number three and am scared to death. I was told that there is no way I would ever be able to have a vbac. One doctor told me that they didnt recommend more than 2 c's but refused to sterilize me or my spouse. Said we were too young and would want more kids. We are in our 30's. So now, when this baby is born, I will be getting my tubes cut tied and burned if I can. I hate that my option of a regular vaginal delivery was taken away from me. I never had any complications in either pregnancy. The distress in my first was the only problem in delivery. I am praying for a positive outcome with this delivery and pregnancy.

I have been doing alot of study on VBAC after multiple C-sections. Wow! Is all I have to say. I have had 3 C-sections 2 emerg. and 1 because I was "probably too small" and if I had a VBAC "I would die". Not once did my Drs. tell me the risks of a C-section- it was always made out to be the safest route. Now I want more children and I'm learning how unsafe it is. My 4th the placenta attached to the scar tissue and came lose two months early. And now I have to decide between life and death to have children. I may have problems carrying with all the scar tissues. But I am learning this on my own. I had gone in for appts with 2 different Drs. to see if I was able to have more and both said no problem but you will need a C-section no VBAC after 2 but not once brought up the risks especially after I almost lost my life last time- C-section is seeming more dangerous than a VBAC. It's a tough road and I seriously think Drs. opt for them because they don't have time to wait for a natural delivery. Easy button for them but not for us moms.